crossing96/oncoscreening huggingface dataset:
Perioperative Complications and In-hospital Mortality After Cystectomy for Nonbladder Cancer Conditions Versus Radical Cystectomy for Bladder Cancer.	OBJECTIVE: This study was designed to test for perioperative complications, mortality, and length of stay after cystectomy for nonbladder cancer (non-BCa) v radical cystectomy (RC) for bladder cancer (BCa). METHODS: Patients were identified within the National Inpatient Sample (2000-2019). Multivariable logistic and Poisson regression models were fitted. RESULTS: Of 26,721 cystectomy patients, 1314 (5%) harbored non-BCa diagnosis: 515 (39%) neurogenic bladder; 379 (29%) radiation cystitis; 238 (18%) interstitial cystitis; 181 (14%) bladder fistula. Relative to RC for BCa, cystectomy for neurogenic bladder, radiation cystitis and bladder fistula resulted in higher genitourinary (22-39 vs. 14%; multivariable odds ratios [MOR] 1.7-3.8), infectious (7-8 vs. 4%; MOR 1.5-2.3), and wound (9 vs. 5%; MOR 1.5-2.0) complications rates. Only cystectomy for neurogenic bladder resulted in higher pulmonary complications (15 vs. 11%; MOR 1.8). Additionally, cystectomy for neurogenic bladder and bladder fistula independently predicted 1.5-fold higher rate of critical care therapy (CCT) use, but only cystectomy for neurogenic bladder exhibited 2.4-fold higher in-hospital mortality rate. Finally, cystectomy for neurogenic bladder, radiation cystitis, and bladder fistula resulted in higher rates of hospital stay ≥ 75th percentile (33-47 vs. 27%; MOR 1.7-2.8). CONCLUSIONS: Relative to RC for BCa, cystectomy for three of four non-BCa conditions resulted in higher rates of four of 12 in-hospital adverse outcomes. Additionally, cystectomy for two of four non-BCa conditions resulted in higher CCT use, but only cystectomy for neurogenic bladder predicted higher rate of in-hospital mortality.	bladder
Towards Defining Follow-up Strategies for Patients with Primary Intermediate-risk Non-muscle-invasive Bladder Cancer.	BACKGROUND AND OBJECTIVE: The current European Association of Urology (EAU) guidelines on non-muscle-invasive bladder cancer (NMIBC) categorize patients into four risk groups. In 2024, a specific follow-up schedule was introduced for intermediate-risk (IR) disease. However, recommendations are based on expert opinion and restricted to patients with IR-NMIBC who have primary low-grade or high-grade/grade 2 disease. Our aim was to identify a subgroup of patients with IR-NMIBC who may require more stringent follow-up. METHODS: We conducted a retrospective analysis of 2086 patients with IR-NMIBC classified according to the World Health Organization 1973 grading scheme. Multivariable Cox-regression models were fitted to identify predictors of recurrence, which were then used to dichotomize groups with low risk of recurrence (IR-Low) versus high risk of recurrence (IR-High). Kaplan-Meier curves were plotted to estimate recurrence-free survival (RFS) and progression-free survival (PFS). Smoothed hazard estimates of first recurrence were plotted by risk group. KEY FINDINGS AND LIMITATIONS: Multifocality and tumor size ≥3 cm were significantly associated with higher risk of first recurrence and were used to define the IR-High and IR-Low (unifocal, size <3 cm; n = 1087) groups. The 3-yr RFS rate was significantly worse for the IR-High group (51%, 95% confidence interval [CI] 48-54%) than for IR-Low (68%, 95% CI 65-71%). The risk of progression was low (5-yr PFS rate 96%) with no significant difference between the IR-High and IR-Low groups. CONCLUSIONS AND CLINICAL IMPLICATIONS: During IR-NMIBC follow-up for recurrence, tumor size and focality should be considered rather than grade. If the primary objective is to ensure prompt detection of recurrence, follow-up schedules should be tailored according to the risk of recurrence, with more stringent protocols for patients with IR-NMIBC at higher risk of recurrence.	bladder
Characterization of Patients with Lymph Node Only Metastatic Urothelial Carcinoma Treated with Nivolumab Plus Gemcitabine-Cisplatin Versus Gemcitabine-Cisplatin Alone from the CheckMate 901 Trial.	Nivolumab (NIVO) plus gemcitabine-cisplatin (GC) demonstrated deep, durable responses in patients with untreated unresectable or metastatic urothelial carcinoma (mUC) with superior overall (OS) and progression-free (PFS) survival versus GC alone. We report post hoc exploratory analyses with 33.6 mo of median follow-up in patients with lymph node (LN) only disease from CheckMate 901. In this phase 3 randomized trial (n = 608), cisplatin-eligible patients received NIVO 360 mg plus GC every 3 wk (Q3W) for six or fewer cycles followed by NIVO 480 mg every 4 wk for ≤2 yr, or GC Q3W for six or fewer cycles. The primary endpoints were OS and PFS by a blinded independent central review (BICR). The objective response rate (ORR) as per the BICR and safety were exploratory. This post hoc analysis evaluated patients with LN only mUC (n = 110). In this subgroup, OS (hazard ratio [HR], 0.58; 95% confidence interval [CI] 0.34-1.00) and PFS (HR, 0.38; 95% CI 0.22-0.66) improved with NIVO + GC versus GC. The ORR was 81% with NIVO + GC versus 64% with GC; complete response rates were 63% versus 34%. The incidence of treatment-related adverse events was similar between arms. In conclusion, clinically meaningful improvements in OS, PFS, and ORR, including twice the rate of complete response and more patients with treatment-free intervals, were observed with NIVO + GC versus GC in patients with LN only disease, providing additional support for first-line NIVO plus cisplatin-based chemotherapy in mUC.	bladder
Non-Invasive Tumor Budding Evaluation and Correlation with Treatment Response in Bladder Cancer: A Multi-Center Cohort Study.	The clinical benefits of neoadjuvant chemoimmunotherapy (NACI) are demonstrated in patients with bladder cancer (BCa); however, more than half fail to achieve a pathological complete response (pCR). This study utilizes multi-center cohorts of 2322 patients with pathologically diagnosed BCa, collected between January 1, 2014, and December 31, 2023, to explore the correlation between tumor budding (TB) status and NACI response and disease prognosis. A deep learning model is developed to noninvasively evaluate TB status based on CT images. The deep learning model accurately predicts the TB status, with area under the curve values of 0.932 (95% confidence interval: 0.898-0.965) in the training cohort, 0.944 (0.897-0.991) in the internal validation cohort, 0.882 (0.832-0.933) in external validation cohort 1, 0.944 (0.908-0.981) in the external validation cohort 2, and 0.854 (0.739-0.970) in the NACI validation cohort. Patients predicted to have a high TB status exhibit a worse prognosis (p < 0.05) and a lower pCR rate of 25.9% (7/20) than those predicted to have a low TB status (pCR rate: 73.9% [17/23]; p < 0.001). Hence, this model may be a reliable, noninvasive tool for predicting TB status, aiding clinicians in prognosis assessment and NACI strategy formulation.	bladder
Relationship between urinary pH and efficacy of Bacillus Calmette-Guérin treatment in patients with carcinoma in situ of the bladder.	PURPOSE: Bacillus Calmette-Guérin (BCG) is the standard treatment for carcinoma in situ (CIS) in patients with urothelial bladder carcinoma. We aimed to determine whether average urinary pH before BCG instillation affects the BCG response. METHODS: Between August 2003 and January 2023, 203 patients with CIS received BCG treatment (Tokyo strain, 80 mg, ≥ 5 times) at our hospital. Average urinary pH was calculated by summing each urinary pH measurement before BCG instillation and dividing by the number of instillations. The Fine-Gray method was used to assess the relationship between average urinary pH (as a continuous variable) and intravesical recurrence. We also analyzed the cumulative incidence of intravesical recurrence after BCG treatment using different cutoff values for average urinary pH (median and trisection of the cohort). RESULTS: The median follow-up period was 45 months (interquartile range (IQR): 14-83 months). The median urinary pH was 6.07 (IQR: 5.68‒6.50). In multivariate analysis, average urinary pH before BCG was significantly associated with intravesical recurrence (hazard ratio: 0.53, 95% confidence interval 0.32-0.89, p = 0.017). The cumulative incidence of intravesical recurrence differed significantly when categorized by average urinary pH (median and trisection), with patients having higher urinary pH showing lower intravesical recurrence rates. CONCLUSION: This is the first study to examine the relationship between BCG response and average urinary pH in patients with CIS. Patients with higher urinary pH had lower intravesical recurrence rates after BCG treatment.	bladder
Identification of a panel of volatile organic compounds in urine for early detection of for bladder cancer.	The absence of specific markers makes early detection of bladder cancer (BC) challenging. Recent studies have reported the reliable diagnostic significance of volatile organic compounds (VOCs) in several cancers. This study aimed to investigate whether urinary VOCs could serve as potential biomarkers for BC. A total of 89 BC patients and 67 healthy individuals were recruited for this study. VOCs in urine samples were detected using gas chromatography-ion mobility spectrometry (GC-IMS). Machine learning algorithms were used to establish diagnostic models for predicting BC based on differential expressed VOCs. Compared with healthy individuals, A total of 20 differentially expressed VOCs were identified, including 17 upregulated and 3 downregulated. Among five machine-learning algorithms, the Random Forests (RF) provided the highest accuracy. Based on RF analysis, eight important VOCs (2-Undecenal, 2-propanone, 1-octanal, Ethyl 2-hydroxybenzoate, 2-ethyl hexanol-D, 2-Pentanone, 1-Propanol,3-(methylthio), 1-nonanal) were identified and used to constructed a diagnostic model, showing the highest diagnostic accuracy and area under the curve (AUC) of 91.5% and 0.958, respectively. Our results suggest a VOCs panel might be used as novel biomarker for early detection of BC.	bladder
Organizational impact of systematic urine culture before Bacillus Calmette Guerin (BCG) induction instillations.	PURPOSE: There are conflicting recommendations concerning the performance of a systematic urine culture (UC) prior to Bacillus Calmette Guerin (BCG) bladder instillations for non-muscle-invasive bladder tumor. The objective was to study the organizational impact of the UC performed before bladder instillations, defined as the number and proportion of BCG instillations postponed due to a positive urine culture result. METHODS: Induction BCG records in a single academic center between 2015 and 2020 were retrospectively reviewed. All patients had a UC prior to each instillation, treated if positive. Risk factors associated with the occurrence of a positive UC, an adverse event or postponement of instillation were studied. RESULTS: A total of 156 patients were included, among which 68.9% of patients had at least one risk factor of UTI and 33% of patients presented at least one positive UC at induction. During BCG induction, 76/909 (8.4%) urine cultures performed were positive and 33% of patients had at least one postponement of BCG instillation. There were 64 instillations postponed, caused by untreated positive urine culture for 40 (62.5%) and absence of urine culture performed for 6 (9.4%) In multivariate analysis, only the presence of lower urinary tract symptoms was significantly associated with a risk of positive UC. CONCLUSION: Positive UC during BCG instillations is a frequent event and a source of disorganization in BCG induction, with possible oncological consequences. A strategy of performing UC only in selected patients, could facilitate proper BCG administration and avoid unreasonable use of antibiotics.	bladder
Can ureteral stents be omitted from radical cystectomy with continent diversion? An ACS-NSQIP analysis of the early postoperative outcomes.	PURPOSE: Radical cystectomy with continent diversion is the standard treatment for muscle-invasive bladder cancer. Evidence supporting the necessity of ureteral stent use after this procedure is limited. This study compares 30-day postoperative outcomes of radical cystectomy with continent diversion using neobladder reconstruction in patients managed with and without ureteral stents. METHODS: A retrospective cohort study using the 2019-2022 ACS-NSQIP database included 1,318 patients who underwent radical cystectomy with continent diversion using neobladder reconstruction. We compared baseline characteristics and perioperative factors between the stented (n = 1,216) and stentless group (n = 102). Univariate and multivariate analyses assessed the relationship between stent use and perioperative outcomes, as well as 1:1 propensity score matching. RESULTS: Patient demographics and comorbidities were comparable between the two groups. Similarly, preoperative and intraoperative factors showed no significant differences, except for a higher drain placement rate in the stented group (98.6% vs. 89.2%, p < 0.001). Postoperatively, the stented cohort exhibited higher odds of minor complications (CD grade 1-2; OR 1.66, p = 0.018), and an increased incidence of progressive renal insufficiency (8.7% vs. 1.3%, p = 0.024) and bleeding requiring transfusion (29.8% vs. 19.6%, p = 0.030). Ureteral obstruction, urinary leak, anastomotic leak rates, hospital stay, and readmission and reoperation rates remained similar between the two groups. Propensity score matching (1:1) for patients with and without stents supported the results of the multivariate logistic regression. CONCLUSION: Stent omission after radical cystectomy with continent diversion using neobladder reconstruction was not associated with significant differences in major complications, ureteral obstruction, readmission, or reoperation rates. It is potentially a safe alternative associated with fewer minor complications.	bladder
Thermosensitive Resiquimod-Loaded Lipid Nanoparticles Promote the Polarization of Tumor-Associated Macrophages to Enhance Bladder Cancer Immunotherapy.	Bladder cancer is a common malignant tumor of the urinary system and is associated with high morbidity, recurrence, and mortality rates. Immunotherapy with immune checkpoint inhibitors has shown great therapeutic outcomes and safety in bladder cancer. Immune checkpoint inhibitors have also been approved as first- and second-line drugs for the treatment of locally advanced or metastatic bladder cancer. However, immunotherapy has a low response and drug assistance for cancer immunotherapy, which can be ascribed to insufficient antigen presentation, tumor immunosuppressive cell accumulation, and T lymphocyte exhaustion in the tumor microenvironment. To overcome the disadvantages of immunotherapy, we prepared a resiquimod (R848)/photothermal agent (DTPA)-loaded lipid nanoparticle (R848/DTPA@DSPE-PEG NP), which has shown good photothermal conversion efficiency, biosafety, and biocompatibility. R848/DTPA@DSPE-PEG NPs with laser irradiation (635 nm) can damage MB49 cells and induce immunogenic cell death in vitro, which could trigger an immune response. Meanwhile, R848/DTPA@DSPE-PEG NPs can also promote M1-like macrophage polarization and dendritic cell maturation in vitro. Moreover, R848/DTPA@DSPE-PEG NPs with 635 nm laser irradiation can suppress subcutaneous and orthotopic bladder tumor growth and activate the immune response, which can promote dendritic cell maturation and M1-like macrophage polarization, enhance CD8+ T lymphocyte infiltration, and reduce M2-like macrophage polarization in tumors. Bioinformatics analysis found that R848/DTPA@DSPE-PEG NPs can also induce immune-related gene overexpression of immune signaling pathways. Combined R848/DTPA@DSPE-PEG NPs with PD-1 antibody can significantly enhance antitumor therapeutic effects, reprogram tumor immunosuppressive microenvironment, and prolong the survival time.	bladder
[A clinical case of bladder metastasis of skin melanoma].	Melanoma is the most aggressive malignant skin neoplasm with a high potential for metastasis and molecular genetic diversity. A clinical case of a 35-year-old patient who admitted to the clinic with a diagnosis of melanoma of the skin on the back of pT2aN2M1b, Clarke invasion stage 3, BRAF (+), metastases to the brain, spine (Th8), who had previously undergone to complete excision of melanoma in 2023, is presented in the article. During examination, bladder tumor was detected. Histological study confirmed the presence of metastatic melanoma of the bladder. Metastatic bladder tumor in patients with melanoma is a rare entity. Surgical treatment can be carried out to improve dysuria and the oncological outcomes, including those patients with synchronous metastases.	bladder
Robot-Assisted Radical Cystectomy With Intracorporeal Ileal Conduit Using the Hinotori Surgical Robot System: A Single Surgeon's Initial Experience of 20 Cases.	BACKGROUND: The objective of this study was to assess the perioperative outcomes of robot-assisted radical cystectomy (RARC) with intracorporeal ileal conduit (ICIC) using the hinotori surgical robot system. METHODS: This retrospective study included 20 consecutive patients with bladder cancer who underwent RARC with ICIC using hinotori from October 2023 to July 2024. Major perioperative outcomes were comprehensively analysed. RESULTS: The median operative time, time using the robotic system, bowel reconstruction and urinary diversion time, and estimated blood loss were 435.0, 330.0, 122.5 min, and 175.0 mL, respectively. No marked intraoperative complications were observed. Perioperative, 30-day, and 90-day complications occurred at rates of 25%, 10%, and 0%, respectively. The learning curve tended to decrease in a case volume-dependent manner. CONCLUSIONS: RARC using hinotori was successfully completed, and favourable perioperative outcomes were achieved without severe complications. This suggests that RARC using hinotori provides a potentially comparable alternative to conventional surgical systems.	bladder
Evaluation of Optimal Sequential Treatment Patterns and Clinical Outcomes in Patients With Advanced Urothelial Carcinoma Treated With First-Line Platinum-Based Chemotherapy: A Multicenter Collaborative Study.	BACKGROUND: Few studies have provided a comprehensive analysis of sequential treatment strategies for locally advanced and metastatic urothelial carcinoma (la/mUC). This study assessed treatment patterns, prognostic factors, and optimal sequencing strategies in patients receiving first-line platinum-based chemotherapy (1 L-PBC). METHODS: This retrospective, multicenter study analyzed 212 la/mUC patients who initiated 1 L-PBC. Treatment sequences were categorized based on the therapy, including immune-oncology (IO) drug and enfortumab vedotin (EV) therapy. Multivariate logistic regression identified risk factors for failing to progress to EV therapy. RESULTS: The median follow-up duration was 17 months. Of the 212 patients, 65 (38.9%) progressed to EV therapy, achieving the longest median overall survival (OS) of 41 months, compared to 25 months in the 1 L-PBC + IO group and 8 months in the 1 L-PBC group. Poor performance status (ECOG-PS ≥ 1), age ≥ 80 years, and elevated levels of C-reactive protein (≥ 1) were significant predictors of failing to reach EV therapy. Kaplan-Meier analysis indicated no survival difference based on avelumab use in patients with no risk factors, but patients with one or more risk factors receiving avelumab had significantly longer OS than patients who did not receive avelumab. CONCLUSIONS: This study emphasizes the prognostic importance of achieving EV therapy and the role of maintenance avelumab in improving outcomes for la/mUC patients with one or more risk factors after 1 L-PBC. Combining EV with pembrolizumab is a promising first-line treatment, and 1 L-PBC remains a viable option for selected patients.	bladder
Management Dilemma for Very High-risk Non-muscle-invasive Bladder Cancer: Real-World Data Challenge the Guideline Recommendation for Upfront Radical Cystectomy.	We discuss real-world evidence that challenges the guideline recommendation of upfront radical cystectomy for all patients with very high-risk non-muscle-invasive bladder cancer. The evidence highlights the need for more accurate and dynamic tools to guide clinical decision-making. Until these are available, treatment decisions should be individualized and made in close consultation with the patient.	bladder
A clinical study of RC48-ADC combined with PD-1 inhibitor in bladder preservation therapy for muscle-invasive bladder cancer (MIBC)-based on real-world data analysis.	OBJECTIVES: This study aimed to evaluate the efficacy and safety of RC48-ADC combined with PD-1 inhibitors in bladder preservation therapy for muscle-invasive bladder cancer (MIBC), and to explore the differences in treatment outcomes between primary and recurrent cases, as well as patients at different clinical stages. METHODS: A retrospective analysis was conducted on 32 patients with clinically non-metastatic MIBC who received ≥ 3 cycles of RC48-ADC combined with PD-1 inhibitor therapy. Clinical efficacy was assessed through integrated imaging and histopathological evaluations. RESULTS: Among the 32 patients, the 1-year progression-free survival (PFS) rate was 84.4%, the objective response rate (ORR) was 68.8%, and the 1-year bladder preservation rate was 68.8%. The primary group was superior to the recurrent group in PFS (94.7% vs. 69.2%), ORR (78.9% vs. 53.8%), and 1-year bladder preservation rate (78.9% vs. 53.8%). Similarly, T2-stage patients exhibited better clinical responses than T3-stage patients in PFS (85.0% vs. 75.0%), ORR (80.0% vs. 54.5%), and 1-year bladder preservation rate (80.0% vs. 54.5%). Treatment-related adverse events (AEs) were predominantly grade I-II, with no severe immune-related complications reported. CONCLUSIONS: The combination of RC48-ADC and PD-1 inhibitors significantly improves bladder preservation rates in MIBC patients with a favorable safety profile, particularly in primary and T2-stage cases. This regimen provides a personalized therapeutic strategy for patients unsuitable for conventional treatments.	bladder
Quality of Life Analysis in Patients with Simple Cutaneous Ureterostomy versus Ileal Conduit Bricker Following Radical Cystectomy.	Introduction: Radical cystectomy (RC) with pelvic lymphadenectomy remains the standard therapeutic approach in the treatment of muscle-invasive bladder cancer (MIBC). The impact of urinary diversion type on postoperative health-related quality of life (HRQoL) remains a debated topic, especially in the context of Eastern European clinical practice. Objective: This retrospective, observational, multicentric study aimed to compare the quality of life in patients undergoing RC followed by either simple cutaneous ureterostomy (SCU) or non-continent ileal conduit (Bricker), across two academic centers in Romania, utilizing different surgical approaches. Material and Methods: A total of 46 patients diagnosed with non-metastatic MIBC were included and equally distributed into two groups. Quality of life was assessed at 3 months postoperatively using the EQ-5D-5L questionnaire and the EQ-VAS visual analogue scale. Indexed scores were calculated using a European value set. A multivariate linear regression was applied to identify independent predictors of quality of life scores. Results: Patients in the Bricker group reported slightly higher EQ-VAS scores. Paradoxically, social support was associated with lower indexed scores (p 0.001), suggesting more severe functional impairment among patients requiring assistance. The type of surgical approach did not significantly impact quality of life. Male patients reported greater limitations in self-care and daily activities (p 0.05). Conclusions: Both urinary diversion techniques yield comparable quality of life outcomes at 3 months postoperatively. Social support may serve as an indirect marker of functional vulnerability, emphasizing the need for an individualized and multidisciplinary approach.	bladder